What are the causes of dysuria (painful urination)?

From the Guidelines

Dysuria is most commonly caused by urinary tract infections (UTIs), particularly those affecting the urethra (urethritis) or bladder (cystitis), with Escherichia coli being the most frequent pathogen, as supported by 1. The causes of dysuria can be broadly categorized into infectious and non-infectious etiologies. Infectious causes include:

• Bacterial infections, such as those caused by Escherichia coli, which is responsible for approximately 75% of recurrent UTIs, as noted in 1
• Sexually transmitted infections like chlamydia, gonorrhea, herpes, and trichomoniasis Non-infectious causes of dysuria include:
• Irritation from soaps, spermicides, or feminine hygiene products
• Anatomical abnormalities, such as cystoceles, bladder or urethral diverticula, and fistulae
• Kidney stones
• Interstitial cystitis
• Prostatitis in men
• Vaginitis in women
• Certain medications
• Trauma to the genitourinary tract, radiation therapy, and tumors Underlying conditions, such as diabetes, may increase susceptibility to infections causing dysuria, as mentioned in 1. According to 1, dysuria is a highly specific symptom for UTI, with more than 90% accuracy in young women, and its evaluation is crucial in diagnosing UTI. Treatment of dysuria depends on identifying the specific cause, with bacterial infections typically requiring appropriate antibiotics, while non-infectious causes may need removal of irritants, anti-inflammatory medications, or specific treatments for underlying conditions.

From the Research

Dysuria Causes

• Dysuria, a feeling of pain or discomfort during urination, can be caused by various factors, including:
  • Urinary tract infection 2, 3
  • Sexually transmitted infection 2, 3
  • Bladder irritants 2
  • Skin lesions 2
  • Chronic pain conditions 2
  • Urethritis 3
  • Vaginitis 3
  • Medication use 3
  • Urethral anatomic abnormalities 3
  • Local trauma 3
  • Interstitial cystitis/bladder pain syndrome 3
• The most common cause of acute dysuria is infection, especially cystitis 3
• Noninfectious inflammatory causes of dysuria include a foreign body in the urinary tract and dermatologic conditions 3
• Noninflammatory causes of dysuria include medication use, urethral anatomic abnormalities, local trauma, and interstitial cystitis/bladder pain syndrome 3

Evaluation and Diagnosis

• History is most often useful for finding signs of sexually transmitted infection, complicated infections, lower urinary symptoms in males, and noninfectious causes 2
• Most patients presenting with dysuria should have a urinalysis performed 2
• Urine culture should be performed for infection to guide appropriate antibiotic use, especially for recurrent or suspected complicated urinary tract infection 2
• Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis 2

Treatment

• Nitrofurantoin is a wide-spectrum antibiotic that can be used to treat urinary tract infections 4
• The use of Nitrofurantoin has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI) 4
• First-line treatment of acute uncomplicated UTI has traditionally involved a 3-day regimen of trimethoprim-sulfamethoxazole (TMP-SMX) or TMP alone for patients with sulfa allergies 5
• Alternative first-line agents include the fluoroquinolones, nitrofurantoin, and fosfomycin 5
• The effectiveness of nitrofurantoin, fosfomycin, and trimethoprim for the treatment of cystitis can be influenced by renal function 6